Effects of rituximab-based B-cell depletion therapy on skin manifestations of lupus erythematosus--report of 17 cases and review of the literature

Abstract

Cutaneous manifestations occur frequently in systemic lupus erythematosus (SLE) and are pathognomonic in subacute-cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Although B-cell depletion therapy (BCDT) has demonstrated efficacy in SLE with visceral involvement, its usefulness for patients with predominant skin manifestations has not been fully established. In this single-centre, retrospective study 14 consecutive SLE, one CCLE and two SCLE patients with recalcitrant skin involvement were treated with 2 × rituximab 1 g, and 1 × cyclophosphamide 750 mg. Six months after BCDT, nine of 17 (53%) patients were in complete (CR) or partial remission (PR). Relapses occurred in 12 patients (71%) at a mean time of 10 ± 1.8 months after BCDT. A second cycle of BCDT achieved a more sustained remission in seven of nine patients (78%) lasting for a mean time of 18.4 ± 2.7 months. Minor adverse events were experienced by three patients. Mean follow-up was 30 months. Our own results and the literature review demonstrate that BCDT based on rituximab is well tolerated and may be effective for cutaneous lesions of lupus erythematosus. Randomized controlled trials are necessary to further evaluate the value of BCDT for this group of patients.

Keywords: Cutaneous lupus; discoid lupus; subacute lupus erythematosus; systemic lupus erythematosus.

Figure 1

Clinical response to BCDT treatment in lupus erythematosus patients with severe cutaneous manifestations treated at UCLH. (a) Bars represent the mucocutaneous BILAG score at zero, three and six months after BCDT in 14 SLE patients. Numbers on the x-axis refer to the patients as described in Table 1. BILAG A indicates a severe mucocutaneous involvement, BILAG B moderate, BILAG C mild and BILAG D inactive mucocutaneous disease. (b) BILAG scores of eight SLE patients who relapsed and received a second cycle of BCDT (mucocutaneous score at zero, three and six months after BCDT).